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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336427404
Report Date: 08/18/2023
Date Signed: 08/18/2023 01:59:42 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/08/2023 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20230808091712
FACILITY NAME:ROBIN MOODY'S CORTRITE COTTAGEFACILITY NUMBER:
336427404
ADMINISTRATOR:MOODY, ROBINFACILITY TYPE:
735
ADDRESS:26642 CORTRITE AVETELEPHONE:
(951) 599-4482
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY:6CENSUS: 3DATE:
08/18/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Robin Moody, LicenseeTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff verbally abused resident in care.
INVESTIGATION FINDINGS:
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On 8/18/2023, Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced visit to conclude the complaint investigation into the allegation listed above. LPA met with Licensee, Robin Moody who was informed of the purpose of the visit. During the investigation, staff, resident, and confidential witness were interviewed.
Regarding the allegation “Staff verbally abused resident in care”, It was alleged Licensee was verbally abusive to resident. Licensee was interviewed who denied verbally abused resident. Interview with resident, revealed Licensee became verbally abusive after resident reported an incident that occurred at the facility to IRC. Resident interview further revealed the verbal abusive happened daily till the resident moved out. Confidential Witness was interviewed who stated Licensee has been observed speaking to resident in a high tone. Substantiated.
Based on LPA’s interviews, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division & Chapter number 6) are being cited on the attached LIC 9099D). An exit interview was conducted, and a copy of this report was reviewed with and provided to Robin Moody.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/08/2023 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20230808091712

FACILITY NAME:ROBIN MOODY'S CORTRITE COTTAGEFACILITY NUMBER:
336427404
ADMINISTRATOR:MOODY, ROBINFACILITY TYPE:
735
ADDRESS:26642 CORTRITE AVETELEPHONE:
(951) 599-4482
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY:6CENSUS: 3DATE:
08/18/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Robin Moody, LicenseeTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
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9
Staff retaliated against resident in care.
INVESTIGATION FINDINGS:
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On 8/18/2023, Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced visit to conclude the complaint investigation into the allegations listed above. LPA met with Licensee, Robin Moody who was informed of the purpose of the visit. During the investigation, staff, and resident were interviewed, resident file was reviewed.
Regarding the allegation “Staff retaliated against resident in care”, it was alleged that Licensee refused to give resident PNI money in retaliation for investigation caused by resident incident report to IRC. Licensee was interviewed who denied retaliated against resident. Licensee reported resident is employed and receives paycheck. Licensee stated the paycheck wasn’t turned into SSA to properly calculate residents SSI, causing the resident to have an overpayment that is being deducted from residents SSI. Licensee stated resident was receiving $1492.82 monthly from SSI but now receives $1176.42 causing her to no longer have the PNI money. LPA reviewed resident’s SSI statements and observed resident had an overpayment from Novermber 2022 through June 2023. Resident’s account statement was reviewed and revealed resident received $1176.42 in July 2023 and August 2023. Unsubstantiated.
Based on interviews with staff, resident, and review of resident’s file there is not enough evidence to support the above allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation are unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Robin Moody.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20230808091712
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ROBIN MOODY'S CORTRITE COTTAGE
FACILITY NUMBER: 336427404
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2023
Section Cited
CCR
80072(a)(3)
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Personal Rights;
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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Licensee stated moving forward licensee will speak to clients with respect.
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This requirement is not met based as evidence by interviews. The licensee did not comply by verbally abusing resident which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
LIC9099 (FAS) - (06/04)
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